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Articles 31 - 60 of 148
Full-Text Articles in Psychiatry
A Comparative Content Analysis Of Emily Dickinson's Letters, Patricia Harrison, M.D., Carol Mcleod, M.A.
A Comparative Content Analysis Of Emily Dickinson's Letters, Patricia Harrison, M.D., Carol Mcleod, M.A.
Jefferson Journal of Psychiatry
To investigate the relationship between creativity and mental illness, a computer content analysis of a random sampling of Emily Dickinson's (ED) letters and a selected sample of ED's "anxiety" letters were compared with speech samples from female subjects with panic disorder (n = 4) and speech samples from a female control group (n = 8). Although this can only be considered a pilot study, the findings suggest that ED's word profiles are more similar to the panic disorder group than to the control group. Limitations of this study (i.e., small sample sizes) and suggestions for future research are discussed.
The Risk Of Hospitalizing Suicidal Patients: A Personal Retrospective, Leora Bar-Levav, M.D.
The Risk Of Hospitalizing Suicidal Patients: A Personal Retrospective, Leora Bar-Levav, M.D.
Jefferson Journal of Psychiatry
Many statistically significant risk factors for suicide have been identified. Unfortunately, no study can identify the patient who will, in fact, kill himself. Maintaining a low threshold for hospitalization of potentially suicidal patients generally lowers their short-term risk. Hospitalization, however, like every medical intervention, carries attendant side effects. The dynamic implications of hospitalization for suicidal patients are considered in this paper along with recommendations to lessen the deleterious effects of such an intervention.
An Overview Of The Separation Phenomenon And The Experience Of Hospitalization For Children, Tara Pressley, M.D.
An Overview Of The Separation Phenomenon And The Experience Of Hospitalization For Children, Tara Pressley, M.D.
Jefferson Journal of Psychiatry
When children are psychologically bonded to a caretaking adult they experience a characteristic spectrum of emotions and behaviors upon being separated from that attachment figure. This paper reviews the literature pertaining to the separation phenomenon and the emotional experience of hospitalisation for children in an attempt to integrate this knowledge into the diagnosis and treatment of children hospitalized medically and psychiatrically.
Panic Disorder And Non-Cardiac Chest Pain: A Brief Review, Ruth Infante, M.D.
Panic Disorder And Non-Cardiac Chest Pain: A Brief Review, Ruth Infante, M.D.
Jefferson Journal of Psychiatry
The relationship between chest pain and panic disorder is explored; after coronary artery disease and other medical diseases have been ruled out, panic disorder remains a significant contributor to morbidity. Panic disorder is treatable; hence it is important that psychiatrists educate the non-psychiatric medical community so that appropriate referrals and treatment can be made. This would lead to a decrease in health care costs.
Neuroleptic Malignant Syndrome: Diagnostic Dilemma In The Medically Ill, Mahmoud A. Parsa, M.D., Andrew J. Picken,, Robert Keating, M.D.
Neuroleptic Malignant Syndrome: Diagnostic Dilemma In The Medically Ill, Mahmoud A. Parsa, M.D., Andrew J. Picken,, Robert Keating, M.D.
Jefferson Journal of Psychiatry
Neuroleptic malignant syndrome is a potentially fatal complication of neuroleptic treatment. It is characterized by a variery of signs and symptoms associated with autonomic instability, and hypothalamic and extrapyramidal dysfunction. Since other medical disorders may mimic its clinical presentation, the accurate recognition of this syndrome in the medical setting is often a diagnostic dilemma. Three medically ill patients with a clinical presentation suggestive of neuroleptic malignant syndrome are presented here. The authors discuss the complexity of making the diagnosis, and offer a brief review of the literature.
A Psychiatric Presentation Of Wernicke's Encephalopathy Following Intravenous Fluid Administration, Douglas Geenans, D.O.
A Psychiatric Presentation Of Wernicke's Encephalopathy Following Intravenous Fluid Administration, Douglas Geenans, D.O.
Jefferson Journal of Psychiatry
Psychiatrists are frequenlly challenged to differentiate primary psychiatric symptoms from those that arise secondary to medical illness. Errors in clinical assessment can lead to significant morbidity and even mortality. Wernicke's encephalopathy is a medical condition that presents, in part, as psychiatric symptomatology. Despite an estimated incidence of 2%, 80% of the cases are undiagnosed. Of its classic triad, ophthalmoplegia and ataxia call be quite subtle, or even absent, whereas mental status changes are present in all but 10% of cases. This disorder, although widely recognized as a complication of alcoholism, has many less frequently considered etiologies, including iatrogenic causes, which …
Demystifying The Psychiatric Case Formulation, Len Sperry, M.D., Ph.D.
Demystifying The Psychiatric Case Formulation, Len Sperry, M.D., Ph.D.
Jefferson Journal of Psychiatry
Until recently case formulation was an ethereal art, in that there was 110 standard, agreed-upon format for conceptualizing and writing formulations. However, the increasing emphasis on accountability in psychiatric care, the trend toward theoretical integration, and the difficulty trainees experience in mastering formulation skills highlight the need for a standard format. The descriptive, etiological and treatment-prognostic components of a formulation are discussed as a standard format for conceptualizing and writing case formulations. Four written formulations are described in terms of content, structure and process to illustrate this format.
Public Perceptions Of Electroconvulsive Therapy: A Historic Review, Steven M. Jenkusky, M.D.
Public Perceptions Of Electroconvulsive Therapy: A Historic Review, Steven M. Jenkusky, M.D.
Jefferson Journal of Psychiatry
Electroconvulsive therapy, an effective treatment for depression, mania and some forms of schizophrenia, has had a tumultuous and controversial history. The dramatic nature of the therapy as well as its use in the mentally ill in a seemingly indiscriminate manner has historically captured the public's attention and concern. The evolution of this therapy and the public and psychiatric profession's responses to it are reviewed here. Often the public's understanding of the therapy, how it is administered, its applications and side effects have lagged behind how the psychiatric profession views ECT, although at times mental health professionals have remained opposed to …
The Mysterious Pathologic Process Of Autistic Disorder, Clyde Sheehan, M.D.
The Mysterious Pathologic Process Of Autistic Disorder, Clyde Sheehan, M.D.
Jefferson Journal of Psychiatry
This is a condensed literature review of current etiological and treatment findings in autism. Numerous studies examining autistic individuals for a biological marker have been performed with renewed interest over the past several years. Biochemical studies have revealed excessive amounts of serotonin, dopamine and opiods in marry autistics. Reductions in self injurious behaviors, aggressiveness, hyperactivity and stereotypies in patients on medications targeting these specific receptor sites have been documented. Though genetic studies indicate a significant contribution to the transmission of autism, the final common etiological pathway remain unknown.
Psychiatric Interventions With Burned Children, Ravi Bhalla, M.D., Diane Kaufman, M.D., Diane Schrier, M.D.
Psychiatric Interventions With Burned Children, Ravi Bhalla, M.D., Diane Kaufman, M.D., Diane Schrier, M.D.
Jefferson Journal of Psychiatry
This paper reviews the literature and identifies etiologic and management factors in the care of the burned child. It was provoked by direct involvement with two sisters, seriously burned under similar circumstances, each at age two. Their suffering is shared by approximately 500,000 children each year. Despite the enormity of the problem, psychological evaluation and treatment interventions are still not routinely incorporated into the care of these children and their caregivers. The authors hope to encourage psychiatrists and other mental health professionals to become more involved in the prevention, diagnosis, treatment, and clinical investigation of the burned child.
The Syndrome Of Antidiuretic Hormone Secretion In Psychiatric Patients, Kathleen Crapanzano, M.D.
The Syndrome Of Antidiuretic Hormone Secretion In Psychiatric Patients, Kathleen Crapanzano, M.D.
Jefferson Journal of Psychiatry
The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common medical illness which has many etiologies-some of which are particular to psychiatric patients. This review will discuss the diagnosis of SIADH and then the various etiologies for its development with emphasis on those which are more relevant to psychiatric patients. Future research will be directed to a further understanding of this disorder, as well as to treatment options to decrease the significant morbidity associated with this condition.
Domperidone For Drug-Induced Orthostatic Hypotension-A Review, Daniel E. Mcdonald, M.D., Raymond W. Lam, M.D., F.R.C.P.(C)
Domperidone For Drug-Induced Orthostatic Hypotension-A Review, Daniel E. Mcdonald, M.D., Raymond W. Lam, M.D., F.R.C.P.(C)
Jefferson Journal of Psychiatry
Drug-induced orthostatic hypotension (OH) is a common side effect of heterocyclic and MAOI antidepressant medications. It usually does not respond to conservative treatment and drug treatments with mineralocorticoids or central dopaminergic antagonists such as metoclopramide have significant long-term side effects that limit their use. Domperidone, a peripherally acting dopaminergic antagonist with few side effects, has been used in a number of small clinical trials to treat OH of various etiologies. We reviewed 9 studies of domperidone in the treatment of OH. Although limited by small sample sizes and poor design, these studies generally showed successful treatment of OH by domperidone. …
Delusional Misidentification Syndromes, Zeljko Jocic, M.D.
Delusional Misidentification Syndromes, Zeljko Jocic, M.D.
Jefferson Journal of Psychiatry
Delusional misidentification syndromes are reviewed by their phenomenology, epidemiology, clinical characteristics, associated clinical findings, etiological theories, diagnostic evaluation, and treatment. Related neuropsychiatric syndromes are described and distinctions between them and delusional misidentification syndromes addressed. Current psychological and biologic-cognitive theories are briefly discussed. These peculiar phenomena are probably more frequent than previously thought, if they are specifically sought and recognized. Organic factors play a definitive role in their occurrence and two brain regions frontal and temporal, are presumably dysfunctional.
Re-Visioning Group Psychotherapy Training In Psychiatry, Len Sperry, M.D., Ph.D.
Re-Visioning Group Psychotherapy Training In Psychiatry, Len Sperry, M.D., Ph.D.
Jefferson Journal of Psychiatry
The literature on group training in psychiatry reveals that most residency programs include didactic seminars but few offer supervised group therapy experience or require competence in referral for group therapy. Not surprisingly, research shows that few residents utilize group therapy-either leading a group or making referrals to groups-after graduation. This paper reviews the current "vision" of group training and offers an alternate vision. The assumptions, group formats and competencies of this new vision are described. Emphasized are the development of skills and competency of making appropriate referrals to groups, which may positively impact resident attitudes and practice patterns regarding group …
Potential Drug Interactions With Coumadin (Warfarin) And Prozac (Fluoxetine): A Brief Report And Review Of The Literature, Robert Jay Claire, M.D., Mark E. Servis, M.D., David L. Cram, Jr., Pharm.D.
Potential Drug Interactions With Coumadin (Warfarin) And Prozac (Fluoxetine): A Brief Report And Review Of The Literature, Robert Jay Claire, M.D., Mark E. Servis, M.D., David L. Cram, Jr., Pharm.D.
Jefferson Journal of Psychiatry
We were asked to see a woman with recurrent depression and a history of deep vein thrombosis. (Consultation and Liaison Service). She had been started initially on Prozac (fluoxetine) and was secondarily started on Coumadin (warfarin). The patient presented with severe bruising of both lower extremities. We were asked to investigate the case to determine if a drug interaction with Prozac had produced the problem. A review of the world's literature failed to produce a report of a drug interaction between Prozac and Coumadin producing a bleeding disorder. Scrutiny of this case could not produce evidence that this occurred. A …
Psychiatric Presentation Of Creutzfeldt-Jakob Disease: A Case Study, Mahmoud A. Parsa, M.D., Kyra Minninger
Psychiatric Presentation Of Creutzfeldt-Jakob Disease: A Case Study, Mahmoud A. Parsa, M.D., Kyra Minninger
Jefferson Journal of Psychiatry
Creutefeldt-Jakob disease is a fatal degenerative disorder of the central nervous system. The variability of its prodromal psychiatric and neurologic manifestation often obscures the diagnosis. This paper reports a case that illustrates the complexity of diagnosing this disease early in the clinical course, and offers a brief review of the literature.
Psychiatric Manifestation Of Vitamin B-12 Deficiency: An Update, David Metzler, M.S., M.D., William H. Miller, M.D., C. Stephen Edwards, M.D.
Psychiatric Manifestation Of Vitamin B-12 Deficiency: An Update, David Metzler, M.S., M.D., William H. Miller, M.D., C. Stephen Edwards, M.D.
Jefferson Journal of Psychiatry
Psychiatric manifestations of vitamin B-12 deficiency are reviewed from 1986 to the present. Specific clinical entities reviewed include depression, organic psychosis, obsessive-compulsive disorder, childhood manifestations and dementia. We recommend that consideration be given to B-12 deficiency as an etiological factor in some cases of depression, organic psychosis, certain childhood disorders and dementia. Routine screening of people overage 65 is addressed.
Psychiatric Consultation For The Demented Elderly, Kenneth Paul Rosenberg, M.D.
Psychiatric Consultation For The Demented Elderly, Kenneth Paul Rosenberg, M.D.
Jefferson Journal of Psychiatry
Psychiatric consultations for the demented elderly are often required and requested by the Medical service. With the rise in the number of demented elderly being housed in acute care hospitals, the need.for these consultations is increasing. In this paper, the author presents a case and discusses the role of the consultant in (1) diagnostics, (2) therapeutics, (3) assessment of involuntary vs. voluntary placement in an institution, (4) medical staff education, (5) family education, and (6) the management of evoked feelings and countertransference among the medical and nursing staff.
Hiv-Positivity, Aids, And The Military Psychiatry Residency Experience, Ronald J. Koshes, M.D.
Hiv-Positivity, Aids, And The Military Psychiatry Residency Experience, Ronald J. Koshes, M.D.
Jefferson Journal of Psychiatry
Psychiatry residents in the military work with a diverse population of HIV-positive and AIDS patients who are in various stages in their illnesses, military careers, and acceptance of the disease process. In this circumstance, the military psychiatry resident must be a clinician, administrator, and patient advocate. Additionally, the military resident must uphold Department of Defense regulations which mandate that soldiers be both physically and emotionally fit to perform their duties. This paper describes the unique role of the military psychiatrist in working with HIV-positive and AIDS patients in the military setting.
The Management Of Performance Anxiety With Beta-Adrenergic Blocking Agents, James A. Bourgeois, M.D.
The Management Of Performance Anxiety With Beta-Adrenergic Blocking Agents, James A. Bourgeois, M.D.
Jefferson Journal of Psychiatry
Performance anxiety consists of several symptoms experienced in the context of public performance and is classified in DSM-III-R under social phobia. Performance anxiety must be distinguished from panic disorder, generalized social phobia, and generalized anxiety disorder. Performance anxiety symptoms can be detrimental to both performer and performance. These symptoms can be controlled by the judicious use of beta-adrenergic blocking agents. The use of beta-adrenergic blocking agents should be considered as part of a psychiatric stress-management program for these patients.
Psychiatry And Cardiac Transplantation, Mark Graham, M.D.
Psychiatry And Cardiac Transplantation, Mark Graham, M.D.
Jefferson Journal of Psychiatry
This paper explores the role of psychiatry in the field of cardiac transplantation by way of a literature review. The various stages of cardiac transplantation are discussed with respect to their time frame within the transplantation process, the cognitive and emotional reactions of patients within a given stage, and the dynamics of staff, patient, and family interactions. Research and clinical experience in the field suggest psychiatric assessment, follow-up, and, when necessary, intervention are valuable and important in promoting successful psychological adjustment as patients face their adaptive tasks in the various stages of the transplantation process.
The Barking Man: A Case Study Of Rootwork In Psychiatry, Harry D. Goldwasser, M.D.
The Barking Man: A Case Study Of Rootwork In Psychiatry, Harry D. Goldwasser, M.D.
Jefferson Journal of Psychiatry
Cultures and sub-cultures attempt to describe illness in ways that are most understandable to the people who live in that community. These groups may differ when describing the etiology, course and treatment of any given ailment. Mental illness is just as susceptible to being explained in a manner which differs from group to group. Not surprisingly, psychiatrists trained under the auspices of "mainstream America"-that is, where the Western Judeo-Christian paradigm reigns, may find themselves dismissing symptoms of other sub-cultures. Some patients may have manifestations of true mental illness; others may have symptoms which are culturally sanctioned but which we label …
Conceptualization Of Therapeutic Alliance During Psychiatric Residency Training, Stephen J. Cozza, M.D.
Conceptualization Of Therapeutic Alliance During Psychiatric Residency Training, Stephen J. Cozza, M.D.
Jefferson Journal of Psychiatry
This pilot study defines the Conceptualization of Therapeutic Alliance (CTA) as the psychotherapist's internalized construct if his ideal patient-therapist relationship based on the principles if Therapeutic Alliance, Working Alliance, and Helping Alliance. The study measures the CTA if third year medical students (MS3s), third year psychiatry residents (PCY3s), and consultant supervising psychotherapists (CSs) utilizing Fiedler's Ideal Therapeutic Relationship Scale. The CTA profiles of each experimental group are correlated with Fiedler's Ideal Therapeutic Relationship. Variance in CTA profiles within each group is also calculated. Preliminary results if this small study (N = 24) show that CTA measurements if the PCY3 group …
Occupational Chemical Exposures And Psychiatric Disorders, Mark L. Dembert, M.D., M.P.H.
Occupational Chemical Exposures And Psychiatric Disorders, Mark L. Dembert, M.D., M.P.H.
Jefferson Journal of Psychiatry
Occupational exposure to metals, solvents, or pesticides can produce disorders of behavior, thought, or mood which can easily be misdiagnosed as 'Junctional." Accurate diagnosis obtained with a relevant clinical history, psychiatric interview, physical examination, and indicated laboratory tests will enable the delivery of necessary medical treatment and concurrently prevent repeat exposure to a hazardous work environment. Published references and organizational sources in occupational medicine and industrial hygiene can beutilized by psychiatrists for determination of the dijferential diagnosis and confirmation of an occupational exposure; in addition, these references can aid in assessing the need for an environmental health hazard survey at …
Subsequent Pregnancy In Women With A History Of Postpartum Psychosis, Richard G. Hersh, M.D.
Subsequent Pregnancy In Women With A History Of Postpartum Psychosis, Richard G. Hersh, M.D.
Jefferson Journal of Psychiatry
Postpartum psychosis stands out among the psychiatric syndromes associated with child birth, not able for the variability of its symptom profile and the potential severity of its course, if unrecognized. Significant questions regarding nosology, etiology, prevention and treatment remain only partially answered (1). While controversy surrounds many of the critical issues regarding postpartum psychosis, including its definition, current epidemiologic data indicates severe, frequently psychotic episodes occur following 1-2 per 1,000 of all births (2). As diagnosis and treatment of puerperal conditions have evolved, clinicians now are frequently involved in assisting women with a history of postpartum psychosis with decision making …
Transference Love And Countertransference Love In Clinical Technique, Ronald J. Koshes, M.D., Colleen E. Sari, M.D.
Transference Love And Countertransference Love In Clinical Technique, Ronald J. Koshes, M.D., Colleen E. Sari, M.D.
Jefferson Journal of Psychiatry
The authors review the original and modern concepts of transference and countertransference love as described by Sigmund Freud followed by the more recent theories of Heinz Kohut and Otto Kernberg, focusing on dynamic clinical importance. Case examples are presented to illustrate the important clinical presentations, problems and pitfalls as well as techniques of managing the eroticized transference. The countertransference implications are especially explored as well as indications for supervision.
A Survey Of Selected Neurological Signs In Schizophrenia Research, Emanuel H. Rosen, M.D.
A Survey Of Selected Neurological Signs In Schizophrenia Research, Emanuel H. Rosen, M.D.
Jefferson Journal of Psychiatry
This review covers three areas of schizophrenia research not usually addressed in residents' curricula: smooth pursuit eye movements and genetics, orienting responses, and tardive dyskinesia. The significance of these neurological signs is explored in terms of their clinical symptom associations and their heuristic value. Neuroanatomical aspects of these signs is noted to be speculatively consistent with hypofrontality and negative symptoms in schieophrenia. The author describes the nature of occulomotor abnormalities and discusses an applicable research study. He summarizes relevant areas of genetic research including linkage analysis and marker studies and explains some of the orienting response abnormalities in schizophrenia. He …
Depression And Poverty Ii. Strategies For Intervention, Donald C. Ohuoha, M.D., M.P.H.
Depression And Poverty Ii. Strategies For Intervention, Donald C. Ohuoha, M.D., M.P.H.
Jefferson Journal of Psychiatry
In Part I of this paper, I reviewed the recent findings in psychosocial causes of depression among the poor, and questions raised by them. In this paper, I will suggest certain strategies for intervention for treatment of this population.
Depression And Poverty I. Psychosocial And Cultural Determinants, Donald C. Ohuoha, M.D., M.P.H.
Depression And Poverty I. Psychosocial And Cultural Determinants, Donald C. Ohuoha, M.D., M.P.H.
Jefferson Journal of Psychiatry
The WorldHealth Organization estimates that over 100 million people worldwide suffer from depression, that three times as many may be affected (1). While major advances have occurred in our understanding of the biological aspects of depression, the understanding of psychosocial causes of depression is still largely sketchy. Thus adequate intervention in dealing with this aspect of treatment of depression is scarce. This paper, divided into two parts, will review recent findings in psychosocial causes of depression and suggest certain strategies.for intervention, speculate on the roles of poverty and the issues raised by poverty on the rates of depression and suggest …
Multiple Personality And Channeling, Rayna L. Rogers, D.O.
Multiple Personality And Channeling, Rayna L. Rogers, D.O.
Jefferson Journal of Psychiatry
Psychiatry in the 1980's and 1990's has seen a rapid progression in the understanding of dissociative disorders, especially multiple personality disorder. Another phenomenon which has had a parallel rise in the past decade is trance channeling. Channeling is the process by which an individual enters a trance-like state and surrenders control of the body to a "guide" or "entity" who communicates with the listeners or "sitters" gathered for a "reading." The purpose of this paper is to investigate the relationship between these two phenomena, specifically questioning whether channeling is a variant of multiple personality disorder or if it is pathological.